ETIOLOGICAL AND EEG PROFILE OF NEONATAL SEIZURE AMONG NEWBORN ATTENDING IN NICU

Dr. Shahana Begum*, Prof. Dr. Wahida Khanam, Dr. Galiba Tasmin, Dr. Mahmuda Hossain, Dr. Mohammad Reazaul Haque, Dr. Ifthekhar Ahmed, Dr. Tanjina Sarifa and Dr. Sabrina Farha Mouree

ABSTRACT

Background: Incidence of seizures is highest during the neonatal period, but clinical diagnosis is often difficult, thereby making it difficult to estimate the true incidence of neonatal seizures. Electroencephalography (EEG) provides a useful noninvasive test to diagnose neonatal seizures and evaluate degree of perinatal damage to brain and long-term prognosis. Objective: To evaluate the clinical, etiological and EEG profile of neonatal seizures. Methods: This cross-sectional study was carried out in NICU of the department of Paediatrics, ICMH, Matuail, Dhaka. The neonates admitted in the NICUs (inborn and out born) from July 2018 to June 2019 were enrolled. A total of 50 neonates who either have seizures during the NICU stay or had seizures which were noticed by other doctors and referred from outside were included in the study. Details history of each baby with a complete description of the seizure, day of onset, duration and frequency were noted. Complete newborn examination was done. Essential and relevant investigations were done such as blood glucose, serum calcium, serum electrolyte, CSF study and USG brain. EEG was done in all the subjects. Statistical analyses was done by using SPSS, version22. Results: In this study it was observed that 29(58.0%) were male and 21(42.0%) were female majority (94.0%) neonates were term. Almost three fourth neonate (72%) neonate had history of delayed crying. The age of onset of seizure within first 24 hours of life were the commonest and contributed to 74% of the total seizures. More than three fourth (78.0%) neonates had seizure frequency of 1-5 per day before admission. More than three fourth (70.0%) neonate duration seizure (each episode) had >5 min. On the basis of examination findings related to etiology it was observed that all (100%) of the neonates were lethargic and majority (82%) of them had poor primitive reflexes and 88% were hypotonic. The study found that Subtle seizures 25 (50%) were the most common type of seizure followed by clonic 17(34%), tonic 6(12.0%) and focal 2(4%). Regarding the seizure etiology, perinatal asphyxia was the major (74%) contributing factor of neonatal seizure, Hypocalcaemia 15(30%) was the next common cause. CNS infection (meningitis) also found in 15(30%) and hyponatremia in 9(18%), hypernatremia in 5(10%) and hypoglycemia 6(12%) of the total seizures. Conclusion: Subtle seizures were the most common type of seizure followed by clonic, tonic and focal. Perinatal asphyxia is the most frequent cause of neonatal seizure, hypocalcemia and CNS infection were the next most common causes followed by metabolic and electrolyte derangement. Almost two third neonates had abnormal. background activities. There was no significant association between EEG findings with etiology and clinical type of neonatal seizure. However further study with large sample is recommended.

Keywords: Neonatal seizure, Electroencephalography, clinical type of seizure, etiology.